Provider Demographics
NPI:1386658052
Name:COMMUNITY MRI SERVICES, LLC
Entity Type:Organization
Organization Name:COMMUNITY MRI SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:PAULSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-297-0305
Mailing Address - Street 1:3223 32ND AVENUE S
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-6278
Mailing Address - Country:US
Mailing Address - Phone:701-297-0305
Mailing Address - Fax:701-235-9660
Practice Address - Street 1:110 N 37TH ST
Practice Address - Street 2:SUITE 302
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-3283
Practice Address - Country:US
Practice Address - Phone:402-379-2810
Practice Address - Fax:702-379-4075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE35820OtherBCBS
141965702OtherFEDERAL WORK COMP
NE35820OtherBCBS